Hypoperfusion in response to epinephrine in local anaesthetics : Investigation of dependence on epinephrine concentration, spread of hypoperfusion and time to maximal cutaneous vasoconstriction
Sheikh, Rafi LU
; Memarzadeh, Khashayar
LU
; Torbrand, Christian
LU
; Blohmé, Jonas
LU
and Malmsjö, Malin
LU
(2017)
In Journal of Plastic, Reconstructive and Aesthetic Surgery
70(3).
p.322-329
- Abstract
Objectives: The present study aimed to examine hypoperfusion in response to epinephrine following the administration of a local anaesthetic. The . concentration of epinephrine that causes maximal hypoperfusion, the . spread of hypoperfusion in the tissue and the . time to the stabilization of hypoperfusion were investigated. Methods: Blood perfusion was monitored using laser Doppler velocimetry and laser speckle contrast imaging of random-pattern advancement flaps (1 × 4 cm) or intact skin on the pig flank. Epinephrine was either injected cumulatively (0.1, 1.0, 10 or 100 μg/ml) after injecting 20 mg/ml lidocaine, to determine the concentration response, or given as a single dose (12.5 μg/ml epinephrine. +. 20 mg/ml lidocaine). Control... (More)
Objectives: The present study aimed to examine hypoperfusion in response to epinephrine following the administration of a local anaesthetic. The . concentration of epinephrine that causes maximal hypoperfusion, the . spread of hypoperfusion in the tissue and the . time to the stabilization of hypoperfusion were investigated. Methods: Blood perfusion was monitored using laser Doppler velocimetry and laser speckle contrast imaging of random-pattern advancement flaps (1 × 4 cm) or intact skin on the pig flank. Epinephrine was either injected cumulatively (0.1, 1.0, 10 or 100 μg/ml) after injecting 20 mg/ml lidocaine, to determine the concentration response, or given as a single dose (12.5 μg/ml epinephrine. +. 20 mg/ml lidocaine). Control experiments were performed with saline or lidocaine (without epinephrine). Results: Increasing concentrations of epinephrine resulted in a gradual decrease in skin perfusion, approaching a minimum after injecting 10 μg/ml. The area of hypoperfusion was 12 mm in radius, and the time from the injection to the stabilization of hypoperfusion was approximately 120 s. After the administration of 10 μg/ml epinephrine in flaps with small pedicle, 25% blood perfusion still remained. Conclusions: Local anaesthetic with an epinephrine concentration of approximately 10 μg/ml appears to be adequate for vasoconstriction before surgery. Incisions were required to be delayed only for 2 min following local anaesthetic with epinephrine in pigs. The remaining 25% blood perfusion observed after the administration of epinephrine supports the use of epinephrine in flaps with a small pedicle. Obviously, these experimental findings must be clinically assessed before being considered for infiltration anaesthesia during plastic surgery procedures.
(Less)
- author
- Sheikh, Rafi
LU
; Memarzadeh, Khashayar
LU
; Torbrand, Christian
LU
; Blohmé, Jonas
LU
and Malmsjö, Malin
LU
- organization
- publishing date
- 2017
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Epinephrine, Laser Doppler velocimetry, Laser speckle contrast imaging, Lidocaine, Local anesthetic, Perfusion
- in
- Journal of Plastic, Reconstructive and Aesthetic Surgery
- volume
- 70
- issue
- 3
- pages
- 322 - 329
- publisher
- Elsevier
- external identifiers
-
- scopus:85007524523
- pmid:27939906
- wos:000398108900004
- ISSN
- 1748-6815
- DOI
- 10.1016/j.bjps.2016.10.017
- project
- Flap monitoring during oculoplastic reconstructive surgery using new non-invasive imaging techniques
- Perfusion Monitoring During Oculoplastic Reconstructive Surgery - Opportunities for Optimization of Surgical Techniques
- Identifying periorbital tumor margins using new non-invasive imaging techniques
- language
- English
- LU publication?
- yes
- id
- c0fe6fce-9c6b-41e6-8d7d-b75064eff509
- date added to LUP
- 2017-01-18 16:42:09
- date last changed
- 2025-01-12 19:41:12
@article{c0fe6fce-9c6b-41e6-8d7d-b75064eff509,
abstract = {{<p>Objectives: The present study aimed to examine hypoperfusion in response to epinephrine following the administration of a local anaesthetic. The . concentration of epinephrine that causes maximal hypoperfusion, the . spread of hypoperfusion in the tissue and the . time to the stabilization of hypoperfusion were investigated. Methods: Blood perfusion was monitored using laser Doppler velocimetry and laser speckle contrast imaging of random-pattern advancement flaps (1 × 4 cm) or intact skin on the pig flank. Epinephrine was either injected cumulatively (0.1, 1.0, 10 or 100 μg/ml) after injecting 20 mg/ml lidocaine, to determine the concentration response, or given as a single dose (12.5 μg/ml epinephrine. +. 20 mg/ml lidocaine). Control experiments were performed with saline or lidocaine (without epinephrine). Results: Increasing concentrations of epinephrine resulted in a gradual decrease in skin perfusion, approaching a minimum after injecting 10 μg/ml. The area of hypoperfusion was 12 mm in radius, and the time from the injection to the stabilization of hypoperfusion was approximately 120 s. After the administration of 10 μg/ml epinephrine in flaps with small pedicle, 25% blood perfusion still remained. Conclusions: Local anaesthetic with an epinephrine concentration of approximately 10 μg/ml appears to be adequate for vasoconstriction before surgery. Incisions were required to be delayed only for 2 min following local anaesthetic with epinephrine in pigs. The remaining 25% blood perfusion observed after the administration of epinephrine supports the use of epinephrine in flaps with a small pedicle. Obviously, these experimental findings must be clinically assessed before being considered for infiltration anaesthesia during plastic surgery procedures.</p>}},
author = {{Sheikh, Rafi and Memarzadeh, Khashayar and Torbrand, Christian and Blohmé, Jonas and Malmsjö, Malin}},
issn = {{1748-6815}},
keywords = {{Epinephrine; Laser Doppler velocimetry; Laser speckle contrast imaging; Lidocaine; Local anesthetic; Perfusion}},
language = {{eng}},
number = {{3}},
pages = {{322--329}},
publisher = {{Elsevier}},
series = {{Journal of Plastic, Reconstructive and Aesthetic Surgery}},
title = {{Hypoperfusion in response to epinephrine in local anaesthetics : Investigation of dependence on epinephrine concentration, spread of hypoperfusion and time to maximal cutaneous vasoconstriction}},
url = {{http://dx.doi.org/10.1016/j.bjps.2016.10.017}},
doi = {{10.1016/j.bjps.2016.10.017}},
volume = {{70}},
year = {{2017}},
}